THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Saturday, April 15, 1995 TAG: 9504150290
SECTION: BUSINESS PAGE: D1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 85 lines
The Department of Defense, looking to cut medical costs for military dependents, is turning to the same technique that private companies use - managed care.
The department on Friday awarded a five-year, $102 million contract to Sentara Health System to set up a health maintenance organization at nine Hampton Roads clinics.
The HMO-type plan, Tricare Prime, will start this October and operate alongside existing plans. Participation will be voluntary, although the military hopes that incentives will lure most people to sign up over the next few years.
``For the government, this is a new venture. We are actually trying to do business in a businesslike manner,'' said Navy Capt. Tom Hood, director of the local Tricare project.
Military officials believe the program will, at the very least, give people better service for the same amount the government pays now. But they hope it will cost less.
``It just makes good sense,'' said Hood. ``We all happen to be taxpayers as well.''
Now, beneficiaries basically have two choices. They can see a private physician, and the visit is covered by the CHAMPUS program. Patients pay a deductible and copayment.
Or they can visit one of the local clinics financed by the military; about 100,000 people use this option each year. A patient calls a central office, which makes an appointment for free care at one of the clinics. There's no guarantee the appointment will be at the closest clinic.
That will change for people who sign up for Tricare Prime. They'll choose a particular clinic, and, in most cases, a particular doctor. They'll get their care from the same place every time, for free.
Sentara is paid a fixed amount by the Defense Department for each person in the HMO. In order to make money, Sentara must take care of each person for less than that amount.
Sentara officials say they try to keep members healthy by emphasizing preventive medicine, including immunizations, screenings, quit-smoking programs and regular physicals.
HMO members who need to see an outside specialist will pay a lot less than they do through CHAMPUS, Sentara officials said. Patients will be guaranteed an appointment within a certain time - probably 24 hours - of their call, and it will be easier than it is now to make appointments for routine physicals.
The clinic services will be the same for people who don't want the HMO, and beneficiaries will still be able to use CHAMPUS.
Sentara is looking to persuade 65,000 people to sign up in the first year of the contract, and it aims for a total of about 97,000 over five years. The HMO will become available to different beneficiaries on a staggered schedule based on rank.
More information is available from the Tricare information line, 677-6000. MEMO: WHERE TO GO
Tricare Prime will be available at clinics at the following sites:
Norfolk
- Little Creek and Shore Drive NAVCARE center
- Boone Clinic on the Amphibious Base
Virginia Beach
- Lynnhaven Parkway NAVCARE center
- Oceana
Portsmouth
- Portsmouth Naval Hospital
- Coast Guard Support Center
Chesapeake
- new clinic at Military Highway and Battlefield Boulevard
Newport News
- Fort Eustis, MacDonald Army Community Hospital
Yorktown
- Yorktown Naval Weapons Station
KEYWORDS: MILITARY DEPENDENTS MEDICAL CARE CLINICS by CNB